Chapter 7 Bankruptcy Forms

COURT CLERK United States Bankruptcy Court TO THE COURT CLERK: Please send me the following information: 1. Copies of all local forms required by this court for an individual (not corporation) filing a Chapter 7 bankruptcy and for making amendments. 2. The number of copies or sets required. 3. The order in which forms should be submitted. 4. Complete instructions on this court’s emergency filing procedures and deadlines. I would also appreciate answers to three questions: 1. Do you require a separate creditor mailing list (matrix)? If so, do you have specific requirements for its format? 2. Is the filing fee still $130? Is the administrative fee still $45? If either have changed, please advise. 3. Should I two-hole punch my papers or is that done by the court? I’ve enclosed a self-addressed envelope for your reply. Thank you. Sincerely, FORM 1. VOLUNTARY PETITION UNITED STATES BANKRUPTCY COURT ______________ DISTRICT OF ________________________ Name of Debtor (if individual, enter Last, First, Middle): Voluntary Petition Name of Joint Debtor (Spouse) (Last, First, Middle): All Other Names used by the Debtor in the last 6 years (include married, maiden, and trade names): All Other Names used by the Joint Debtor in the last 6 years (include married, maiden, and trade names): Soc. Sec./Tax I.D. No. (if more than one, state all): Soc. Sec./Tax I.D. No. (if more than one, state all): Street Address of Debtor (No. & Street, City, State & Zip Code): Street Address of Joint Debtor (No. & Street, City, State & Zip Code): County of Residence or of the Principal Place of Business: Mailing Address of Debtor (if different from street address): County of Residence or of the Principal Place of Business: Mailing Address of Joint Debtor (if different from street address): Location of Principal Assets of Business Debtor (if different from street address above): Information Regarding the Debtor (Check the Applicable Boxes) Venue (Check any applicable box) Debtor has been domiciled or has had a residence, principal place of business, or principal assets in this District for 180 days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District. There is a bankruptcy case concerning debtor’s affiliate, general partner, or partnership pending in this District. Type of Debtor (Check all boxes that apply) Individual(s) Railroad Corporation Stockbroker Partnership Commodity Broker Other _____________________ Nature of Debts (Check one box) Consumer/Non-Business Business Chapter 11 Small Business (Check all boxes that apply) Debtor is a small business as defined in 11 U.S.C. § 101 Debtor is and elects to be considered a small business under 11 U.S.C. §1121(e) (Optional) Chapter or Section of Bankruptcy Code Under Which the Petition is Filed (Check one box) Chapter 7 Chapter 11 Chapter 13 Chapter 9 Chapter 12 Sec. 304 – Case ancillary to foreign proceeding Filing Fee (Check one box) Full Filing Fee attached Filing Fee to be paid in installments. (Applicable to individuals only.) Must attach signed application for the court’s consideration certifying that the debtor is unable to pay fee except in installments. Rule 1006(b). See Official Form No. 3. Statistical/Administrative Information (Estimates only) Debtor estimates that funds will be available for distribution to unsecured creditors. Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for distribution to unsecured creditors. Estimated Number of Creditors Estimated Assets $0 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1 million $1,000,001 to $10 million $10,000,001 to $50 million $50,000,001 $100 million More than $100 million 1-15 16-49 50-99 100-199 200-999 1000-over THIS SPACE FOR COURT USE ONLY Estimated Debts $0 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1 million $1,000,001 to $10 million $10,000,001 to $50 million $50,000,001 $100 million More than $100 million Voluntary Petition Location Where Filed: Name of Debtor(s): Form 1, Page 2 (This page must be completed and filed in every case.) Prior Bankruptcy Case Filed Within Last 6 Years (If more than one, attach additional sheet) Case Number: Date Filed: Pending Bankruptcy Case Filed by any Spouse, Partner or Affiliate of this Debtor (If more than one, attach additional sheet) Name of Debtor: Case Number: Date Filed: District: Relationship: Judge: Signatures Signature(s) of Debtor(s) (Individual/Joint) I declare under penalty of perjury that the information provided in this petition is true and correct. [If petitioner is an individual whose debts are primarily consumer debts and has chosen to file under chapter 7] I am aware that I may proceed under chapter 7, 11, 12 or 13 of title 11, United States Code, understand the relief available under each such chapter, and choose to proceed under chapter 7. I request relief in accordance with the chapter of title 11, United States Code, specified in this petition. X ______________________________________________________ Signature of Debtor Signature of Debtor (Corporation/Partnership) I declare under penalty of perjury that the information provided in this petition is true and correct and that I have been authorized to file this petition on behalf of the debtor. The debtor requests relief in accordance with the chapter of title 11, United States Code, specified in this petition. X ______________________________________________________ Signature of Authorized Individual ______________________________________________________ Printed Name of Authorized Individual Title of Authorized Individual X ______________________________________________________ Signature of Joint Debtor ______________________________________________________ ______________________________________________________ Date ______________________________________________________ Telephone Number (If not represented by attorney) Date ______________________________________________________ Signature of Attorney X ______________________________________________________ Signature of Attorney for Debtor(s) Signature of Non-Attorney Petition Preparer I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document. ______________________________________________________ Printed Name of Bankruptcy Petition Preparer ______________________________________________________ Printed Name of Attorney for Debtor(s) ______________________________________________________ Firm Name Address ______________________________________________________ Social Security Number ______________________________________________________ ______________________________________________________ ______________________________________________________ Telephone Number ______________________________________________________ Address ______________________________________________________ Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document: ______________________________________________________ Date Exhibit A (To be completed if debtor is required to file periodic reports (e.g., forms 10K and 10Q) with the Securities and Exchange Commission pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 and is requesting relief under chapter 11.) Exhibit A is attached and made a part of this petition. Exhibit B (To be completed if debtor is an individual whose debts are primarily consumer debts.) I, the attorney for the petitioner named in the foregoing petition, declare that I have informed the petitioner that [he or she] may proceed under chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief available under each such chapter. X ______________________________________________________ Signature of Attorney for Debtor(s) Date If more than one person prepared this document, attach additional sheets conforming to the appropriate official form for each person. X ______________________________________________________ Signature of Bankruptcy Petition Preparer Date ______________________________________________________ A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156. In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE A—REAL PROPERTY Except as directed below, list all real property in which the debtor has any legal, equitable, or future interest, including all property owned as a co-tenant, community property, or in which the debtor has a life estate. Include any property in which the debtor holds rights and powers exercisable for the debtor’s own benefit. If the debtor is married, state whether husband, wife, or both own the property by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the debtor holds no interest in real property, write “None” under “Description and Location of Property.” Do not include interests in executory contracts and unexpired leases on this schedule. List them in Schedule G—Executory Contracts and Unexpired Leases. If an entity claims to have a lien or hold a secured interest in any property, state the amount of the secured claim. See Schedule D. If no entity claims to hold a secured interest in the property, write “None” in the column labeled “Amount of Secured Claim.” If the debtor is an individual or if a joint petition is filed, state the amount of any exception claimed in the property only in Schedule C— Property Claimed as Exempt. HUSBAND, WIFE, JOINT, OR COMMUNITY CURRENT MARKET VALUE OF DEBTOR’S INTEREST IN PROPERTY WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION AMOUNT OF SECURED CLAIM NATURE OF DEBTOR’S DESCRIPTION AND LOCATION OF PROPERTY INTEREST IN PROPERTY Total ➡ $ (Report also on Summary of Schedules.) In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE B—PERSONAL PROPERTY Except as directed below, list all personal property of the debtor of whatever kind. If the debtor has no property in one or more of the categories, place an “X” in the appropriate position in the column labeled “None.” If additional space is needed in any category, attach a separate sheet properly identified with the case name, case number, and the number of the category. If the debtor is married, state whether husband, wife, or both own the property by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the debtor is an individual or a joint petition is filed, state the amount of any exemptions claimed only in Schedule C—Property Claimed as Exempt. Do not include interests in executory contracts and unexpired leases on this schedule. List them in Schedule G—Executory Contracts and Unexpired Leases. If the property is being held for the debtor by someone else, state that person’s name and address under “Description and Location of Property.” HUSBAND, WIFE, JOINT, OR COMMUNITY CURRENT MARKET VALUE OF DEBTOR’S INTEREST IN PROPERTY, WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION TYPE OF PROPERTY NONE DESCRIPTION AND LOCATION OF PROPERTY 1. 2. Cash on hand. Checking, savings or other financial accounts, certificates of deposit, or shares in banks, savings and loan, thrift, building and loan, and homestead associations, or credit unions, brokerage houses, or cooperatives. 3. Security deposits with public utilities, telephone companies, landlords, and others. 4. Household goods and furnishings, including audio, video, and computer equipment. In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE B—PERSONAL PROPERTY (Continuation Sheet) HUSBAND, WIFE, JOINT, OR COMMUNITY CURRENT MARKET VALUE OF DEBTOR’S INTEREST IN PROPERTY, WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION TYPE OF PROPERTY NONE DESCRIPTION AND LOCATION OF PROPERTY 5. Books, pictures and other art objects, antiques, stamp, coin, record, tape, compact disc, and other collections or collectibles. Wearing apparel. Furs and jewelry. 6. 7. 8. Firearms and sports, photo graphic, and other hobby equipment. Interests in insurance policies. Name insurance company of each policy and itemize surrender or refund value of each. 9. 10. Annuities. Itemize and name each issuer. 11. Interests in IRA, ERISA, Keogh, or other pension or profit sharing plans. Itemize. 12. Stock and interests in incorporated and unincorporated businesses. Itemize. 13. Interests in partnerships or joint ventures. Itemize. In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE B—PERSONAL PROPERTY (Continuation Sheet) HUSBAND, WIFE, JOINT, OR COMMUNITY CURRENT MARKET VALUE OF DEBTOR’S INTEREST IN PROPERTY, WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION TYPE OF PROPERTY NONE DESCRIPTION AND LOCATION OF PROPERTY 14. Government and corporate bonds and other negotiable and non-negotiable instruments. 15. Accounts receivable. 16. Alimony, maintenance, sup port, and property settlements to which the debtor is or may be entitled. Give particulars. 17. Other liquidated debts owing debtor including tax refunds. Give particulars. 18. Equitable or future interest, life estates, and rights or powers exercisable for the benefit of the debtor other than those listed in Schedule of Real Property. 19. Contingent and noncontin gent interests in estate of a decedent, death benefit plan, life insurance policy, or trust. 20. Other contingent and unliquidated claims of every nature, including tax refunds, counter claims of the debtor, and rights to setoff claims. Give estimated value of each. 21. Patents, copyrights, and other intellectual property. Give particulars. 22. Licenses, franchises, and other general intangibles. Give particulars. In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE B—PERSONAL PROPERTY (Continuation Sheet) HUSBAND, WIFE, JOINT, OR COMMUNITY CURRENT MARKET VALUE OF DEBTOR’S INTEREST IN PROPERTY, WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION TYPE OF PROPERTY NONE DESCRIPTION AND LOCATION OF PROPERTY 23. Automobiles, trucks, trailers, and other vehicles and acces sories. 24. Boats, motors, and accessories. 25. Aircraft and accessories. 26. Office equipment, furnishings, and supplies. 27. Machinery, fixtures, equipment, and supplies used in business. 28. Inventory. 29. Animals. 30. Crops—growing or harvested. Give particulars. 31. Farming equipment and implements. 32. Farm supplies, chemicals, and feed. 33. Other personal property of any kind not already listed, such as season tickets. Itemize. Total ________ continuation sheets attached ➡ $ (Include amounts from any continuation sheets attached. Report total also on Summary of Schedules.) In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE C—PROPERTY CLAIMED AS EXEMPT Debtor elects the exemptions to which debtor is entitled under: (Check one box) s 11 U.S.C. § 522(b)(1): s 11 U.S.C. § 522(b)(2): Exemptions provided in 11 U.S.C. § 522(d). Note: These exemptions are available only in certain states. Exemptions available under applicable nonbankruptcy federal laws, state or local law where the debtor’s domicile has been located for the 180 days immediately preceding the filing of the petition, or for a longer portion of the 180-day period than in any other place, and the debtor’s interest as a tenant by the entirety or joint tenant to the extent the interest is exempt from process under applicable nonbankruptcy law. CURRENT MARKET VALUE OF SPECIFY LAW PROVIDING DESCRIPTION OF PROPERTY EACH EXEMPTION VALUE OF CLAIMED EXEMPTION PROPERTY WITHOUT DEDUCTING EXEMPTIONS n In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE D—CREDITORS HOLDING SECURED CLAIMS State the name, mailing address, including zip code, and account number, if any, of all entities holding claims secured by property of the debtor as of the date of filing of the petition. List creditors holding all types of secured interest such as judgment liens, garnishments, statutory liens, mortgages, deeds of trust, and other security interests. List creditors in alphabetical order to the extent practicable. If all secured creditors will not fit on this page, use the continuation sheet provided. If any entity other than a spouse in a joint case may be jointly liable on a claim, place an “X” in the column labeled “Codebtor,” include the entity on the appropriate schedule of creditors, and complete Schedule H—Codebtors. If a joint petition is filed, state whether husband, wife, both of them, or the marital community may be liable on each claim by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the claim is contingent, place an “X” in the column labeled “Contingent.” If the claim is unliquidated, place an “X” in the column labeled “Unliquidated.” If the claim is disputed, place an “X” in the column labeled “Disputed.” (You may need to place an “X” in more than one of these three columns.) Report the total of all claims listed on this schedule in the box labeled “Total” on the last sheet of the completed schedule. Report this total also on the Summary of Schedules. s Check this box if debtor has no creditors holding secured claims to report on this Schedule D. HUSBAND, WIFE, JOINT, OR COMMUNITY UNLIQUIDATED CONTINGENT AMOUNT OF DISPUTED CLAIM WITHOUT DEDUCTING VALUE OF COLLATERAL UNSECURED PORTION, IF ANY CODEBTOR DATE CLAIM WAS INCURRED, NATURE OF LIEN, AND DESCRIPTION AND MARKET VALUE OF PROPERTY SUBJECT TO LIEN CREDITOR’S NAME AND MAILING ADDRESS INCLUDING ZIP CODE ACCOUNT NO. VALUE $ ACCOUNT NO. VALUE $ ACCOUNT NO. VALUE $ ACCOUNT NO. VALUE $ _________ continuation sheets attached Subtotal ➡ $ (Total of this page) Total ➡ $ (Use only on last page) (Report total also on Summary of Schedules) In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE D—CREDITORS HOLDING SECURED CLAIMS (Continuation Sheet) HUSBAND, WIFE, JOINT, OR COMMUNITY UNLIQUIDATED CONTINGENT AMOUNT OF DISPUTED CODEBTOR DATE CLAIM WAS INCURRED, NATURE OF LIEN, AND DESCRIPTION AND MARKET VALUE OF PROPERTY SUBJECT TO LIEN CLAIM WITHOUT DEDUCTING VALUE OF COLLATERAL UNSECURED PORTION, IF ANY CREDITOR’S NAME AND MAILING ADDRESS INCLUDING ZIP CODE ACCOUNT NO. VALUE $ ACCOUNT NO. VALUE $ ACCOUNT NO. VALUE $ ACCOUNT NO. VALUE $ ACCOUNT NO. VALUE $ ACCOUNT NO. VALUE $ Sheet no. ________ of ________ continuation sheets attached to Schedule of Creditors Holding Secured Claims Subtotal ➡ $ (Total of this page ) Total ➡ $ (Use only on last page ) (Report total also on Summary of Schedules) In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE E—CREDITORS HOLDING UNSECURED PRIORITY CLAIMS A complete list of claims entitled to priority, listed separately by type of priority, is to be set forth on the sheets provided. Only holders of unsecured claims entitled to priority should be listed in this schedule. In the boxes provided on the attached sheets, state the name and mailing address, including zip code, and account number, if any, of all entities holding priority claims against the debtor or the property of the debtor, as of the date of the filing of the petition. If any entity other than a spouse in a joint case may be jointly liable on a claim, place an “X” in the column labeled “Codebtor,” include the entity on the appropriate schedule of creditors, and complete Schedule H—Codebtors. If a joint petition is filed, state whether husband, wife, both of them, or the marital community may be liable on each claim by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the claim is contingent, place an “X” in the column labeled “Contingent.” If the claim is unliquidated, place an “X” in the column labeled “Unliquidated.” If the claim is disputed, place an “X” in the column labeled “Disputed.” (You may need to place an “X” in more than one of these three columns.) Report the total of all claims listed on each sheet in the box labeled “Subtotal” on each sheet. Report the total of all claims listed on this Schedule E in the box labeled “Total” on the last sheet of the completed schedule. Repeat this total also on the Summary of Schedules. s Check this box if debtor has no creditors holding unsecured priority claims to report on this Schedule E. TYPES OF PRIORITY CLAIMS (Check the appropriate box(es) below if claims in that category are listed on the attached sheets) s Extensions of credit in an involuntary case Claims arising in the ordinary course of the debtor’s business or financial affairs after the commencement of the case but before the earlier of the appointment of a trustee or the order for relief. 11 U.S.C. § 507(a)(2). s Wages, salaries, and commissions Wages, salaries, and commissions, including vacation, severance, and sick leave pay owing to employees and commissions owing to qualifying independent sales representatives up to $4,300* per person, earned within 90 days immediately preceding the filing of the original petition, or the cessation of business, whichever occurred first, to the extent provided in 11 U.S.C. § 507(a)(3). s Contributions to employee benefit plans Money owed to employee benefit plans for services rendered within 180 days immediately preceding the filing of the original petition, or the cessation of business, whichever occurred first, to the extent provided in 11 U.S.C. § 507(a)(4). s Certain farmers and fishermen Claims of certain farmers and fishermen, up to a maximum of $4,300* per farmer or fisherman, against the debtor, as provided in 11 U.S.C. § 507(a)(5). s Deposits by individuals Claims of individuals up to a maximum of $1,950* for deposits for the purchase, lease, or rental of property or services for personal, family, or household use, that were not delivered or provided. 11 U.S.C. § 507(a)(6). s Alimony, Maintenance, or Support Claims of a spouse, former spouse, or child of the debtor for alimony, maintenance, or support, to the extent provided in 11 U.S.C. § 507(a)(7). s Taxes and Certain Other Debts Owed to Governmental Units Taxes, customs, duties, and penalties owing to federal, state, and local governmental units as set forth in 11 U.S.C. § 507(a)(8). s Commitments to Maintain the Capital of an Insured Depository Institution Claims based on commitments to the FDIC, RTC, Director of the Office of Thrift Supervision, Comptroller of the Currency, or Board of Governors of the Federal Reserve system, or their predecessors or successors, to maintain the capital of an insured depository institution. 11 U.S.C. § 507 (a)(9). * Amounts are subject to adjustment on April 1, 1998, and every three years thereafter with respect to cases commenced on or after the date of adjustment. ____ continuation sheets attached In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE E—CREDITORS HOLDING UNSECURED PRIORITY CLAIMS (Continuation Sheet) TYPE OF PRIORITY HUSBAND, WIFE, JOINT, OR COMMUNITY CONTINGENT UNLIQUIDATED CODEBTOR DISPUTED AMOUNT TOTAL AMOUNT OF CLAIM ENTITLED TO PRIORITY CREDITOR’S NAME AND MAILING ADDRESS INCLUDING ZIP CODE ACCOUNT NO. DATE CLAIM WAS INCURRED AND CONSIDERATION FOR CLAIM ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. Sheet no. _______ of _______ sheets attached to Schedule of Creditors Holding Unsecured Priority Claims Subtotal ➡ $ (Total of this page) Total ➡ $ (Use only on last page) (Report total also on Summary of Schedules) In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE F—CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS State the name, mailing address, including zip code, and account number, if any, of all entities holding unsecured claims without priority against the debtor or the property of the debtor as of the date of filing of the petition. Do not include claims listed in Schedules D and E. If all creditors will not fit on this page, use the continuation sheet provided. If any entity other than a spouse in a joint case may be jointly liable on a claim, place an “X” in the column labeled “Codebtor,” include the entity on the appropriate schedule of creditors, and complete Schedule H—Codebtors. If a joint petition is filed, state whether husband, wife, both of them, or the marital community may be liable on each claim by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the claim is contingent, place an “X” in the column labeled “Contingent.” If the claim is unliquidated, place an “X” in the column labeled “Unliquidated.” If the claim is disputed, place an “X” in the column labeled “Disputed.” (You may need to place an “X” in more than one of these three columns.) Report the total of all claims listed on this schedule in the box labeled “Total” on the last sheet of the completed schedule. Report this total also on the Summary of Schedules. s Check this box if debtor has no creditors holding unsecured nonpriority claims to report on this Schedule F. HUSBAND, WIFE, JOINT, OR COMMUNITY CONTINGENT UNLIQUIDATED CODEBTOR DATE CLAIM WAS INCURRED AND CONSIDERATION FOR CLAIM. IF CLAIM IS SUBJECT TO SETOFF, SO STATE CREDITOR’S NAME AND MAILING ADDRESS INCLUDING ZIP CODE ACCOUNT NO. DISPUTED AMOUNT OF CLAIM ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. ______________ continuation sheets attached Subtotal ➡ (Total of this page) $ Total ➡ $ (Use only on last page) (Report total also on Summary of Schedules) In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE F—CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS (Continuation Sheet) HUSBAND, WIFE, JOINT, OR COMMUNITY CONTINGENT UNLIQUIDATED CODEBTOR DATE CLAIM WAS INCURRED AND CONSIDERATION FOR CLAIM. IF CLAIM IS SUBJECT TO SETOFF, SO STATE CREDITOR’S NAME AND MAILING ADDRESS INCLUDING ZIP CODE ACCOUNT NO. DISPUTED AMOUNT OF CLAIM ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. Subtotal Sheet no. ________ of ________ continuation sheets attached to Schedule of Creditors Holding Unsecured Nonpriorty Claims ➡ (Total of this page ) Total ➡ (Use only on last page ) $ $ (Report total also on Summary of Schedules) In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE G—EXECUTORY CONTRACTS AND UNEXPIRED LEASES Describe all executory contracts of any nature and all unexpired leases of real personal property. Include any timeshare interests. State nature of debtor’s interest in contract, i.e., “Purchaser,” “Agent,” etc. State whether debtor is the lessor or lessee of a lease. Provide the names and complete mailing addresses of all other parties to each lease or contract described. NOTE: A party listed on this schedule will not receive notice of the filing of this case unless the party is also scheduled in the appropriate schedule of creditors. s Check this box if debtor has no executory contracts or unexpired leases. DESCRIPTION OF CONTRACT OR LEASE AND NATURE OF DEBTOR’S INTEREST. STATE WHETHER LEASE IS FOR NONRESIDENTIAL REAL NAME AND MAILING ADDRESS, INCLUDING ZIP CODE, OF OTHER PARTIES TO LEASE OR CONTRACT PROPERTY. STATE CONTRACT NUMBER OF ANY GOVERNMENT CONTRACT n In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE H—CODEBTORS Provide the information requested concerning any person or entity, other than a spouse in a joint case, that is also liable on any debts listed by debtor in the schedules of creditors. Include all guarantors and co-signers. In community property states, a married debtor not filing a joint case should report the name and address of the nondebtor spouse on this schedule. Include all names used by the nondebtor spouse during the six years immediately preceding the commencement of this case. s Check this box if debtor has no codebtors. NAME AND ADDRESS OF CODEBTOR NAME AND ADDRESS OF CREDITOR n In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE I—CURRENT INCOME OF INDIVIDUAL DEBTOR(S) The column labled “Spouse” must be completed in all cases filed by joint debtors and by a married debtor in a Chapter 12 or 13 case whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed. DEBTOR’S MARITAL DEPENDENTS OF DEBTOR AND SPOUSE STATUS: NAMES AGE RELATIONSHIP Employment: Occupation Name of Employer How long employed Address of Employer INCOME: (Estimate of average monthly income) DEBTOR SPOUSE DEBTOR $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ SPOUSE $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ Current monthly gross wages, salary, and commissions (pro rate if not paid monthly) Estimated monthly overtime SUBTOTAL LESS PAYROLL DEDUCTIONS a. Payroll taxes and Social Security b. Insurance c. Union dues d. Other (Specify: ________________________________________________ ) SUBTOTAL OF PAYROLL DEDUCTIONS TOTAL NET MONTHLY TAKE HOME PAY Regular income from operation of business or profession or farm (attach detailed statement) Income from real property Interest and dividends Alimony, maintenance or support payments payable to the debtor for the debtor’s use or that of dependents listed above Social Security or other government assistance (Specify: ____________________________________________________________ ) Pension or retirement income Other monthly income (Specify: ____________________________________________________________ ) _____________________________________________________________ TOTAL MONTHLY INCOME TOTAL COMBINED MONTHLY INCOME $ _______________________ $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ $ _____________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ (Report also on Summary of Schedules) Describe any increase or decrease of more than 10% in any of the above categories anticipated to occur within the year following the filing of this document: In re _______________________________________________, Debtor Case No._____________________________ (If known) SCHEDULE J—CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S) Complete this schedule by estimating the average monthly expenses of the debtor and the debtor’s family. Pro rate any payments made bi-weekly, quarterly, semi-annually, or annually to show monthly rate. s Check this box if a joint petition is filed and debtor’s spouse maintains a separate household. Complete a separate schedule of expenditures labeled “Spouse.” Rent or home mortgage payment (include lot rented for mobile home) Are real estate taxes included? Is property insurance included? Utilities: Electricity and heating fuel Water and sewer Telephone Other _______________________________________________________________________________ Home maintenance (repairs and upkeep) Food Clothing Laundry and dry cleaning Medical and dental expenses Transportation (not including car payments) Recreation, clubs and entertainment, newspapers, magazines, etc. Charitable contributions Insurance (not deducted from wages or included in home mortgage payments) Homeowner’s or renter’s Life Health Auto Other _______________________________________________________________________________ Taxes (not deducted from wages or included in home mortgage payments) (Specify: ____________________________________________________________________________________ ) Installment payments: (In Chapter 12 and 13 cases, do not list payments to be included in the plan) Auto Other _______________________________________________________________________________ Other _______________________________________________________________________________ Alimony, maintenance, and support paid to others Payments for support of additional dependents not living at your home Regular expenses from operation of business, profession, or farm (attach detailed statement) Other ________________________________________________________________________________________ TOTAL MONTHLY EXPENSES (Report also on Summary of Schedules) $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ Yes ______ Yes ______ No ______ No ______ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ $ _______________ [FOR CHAPTER 12 AND CHAPTER 13 DEBTORS ONLY] Provide the information requested below, including whether plan payments are to be made bi-weekly, monthly, annually, or at some other regular interval. A. Total projected monthly income B. Total projected monthly expenses C. Excess income (A minus B) D. Total amount to be paid into plan each __________________________________________________________ (interval) $ _______________ $ _______________ $ _______________ $ _______________ United States Bankruptcy Court ______________________________ District of ______________________________ In re _______________________________________________, Debtor Case No._____________________________ (If known) SUMMARY OF SCHEDULES Indicate as to each schedule whether that schedule is attached and state the number of pages in each. Report the totals from Schedules A, B, D, E, F, I and J in the boxes provided. Add the amounts from Schedules A and B to determine the total amount of the debtor’s assets. Add the amounts from Schedules D, E and F to determine the total amount of the debtor’s liabilities. AMOUNTS SCHEDULED NAME OF SCHEDULE A Real Property ATTACHED (YES/NO) NUMBER OF SHEETS $ ASSETS LIABILITIES OTHER B Personal Property Property Claimed as Exempt Creditors Holding Secured Claims Creditors Holding Unsecured Priority Claims Creditors Holding Unsecured Nonpriority Claims Executory Contracts and Unexpired Leases Codebtors Current Income of Individual Debtor(s) Current Expenditures of Individual Debtor(s) Total Number of Sheets of All Schedules ➡ $ C D $ E $ F $ G H I $ J $ Total Assets ➡ $ Total Liabilities ➡ $ In re _______________________________________________, Debtor Case No._____________________________ (If known) DECLARATION CONCERNING DEBTOR’S SCHEDULES DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR I declare under penalty of perjury that I have read the foregoing summary and schedules consisting of ______________________________ (Total shown on summary page plus 1) sheets, and that they are true and correct to the best of my knowledge, information, and belief. Date___________________________________ Signature ________________________________________________________ Debtor Date___________________________________ Signature ________________________________________________________ (Joint Debtor, if any) [If joint case, both spouses must sign.] CERTIFICATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document. Printed or Typed Name of Bankruptcy Petition Preparer Social Security No. Address Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document: If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person. X Signature of Bankruptcy Petition Preparer Date A bankruptcy petition preparer’s failure to comply with the provisions of Title 11 and the Federal Rules of Bankruptcy Procedure may result in fine or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156. DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF CORPORATION OR PARTNERSHIP I, the _________________________________________________ [the president or other officer or an authorized agent of the corporation or a member or an authorized agent of the partnership] of the _____________________________________________ [corporation or partnership] named as debtor in this case, declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of ______________________________ sheets, and that they are true and correct to the best of my knowledge, information, and belief. (Total shown on summary page plus 1) Date___________________________________ Signature ________________________________________________________ _______________________________________________________ [Print or type name of individual signing on behalf of debtor] [An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.] Penalty for making a false statement or concealing property: Fine of up to $500,000, imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 and 3571. FORM 7. STATEMENT OF FINANCIAL AFFAIRS UNITED STATES BANKRUPTCY COURT _________________________ DISTRICT OF _________________________ In re: _________________________________________________ , (Name) Debtor Case No. __________________________ (If known) STATEMENT OF FINANCIAL AFFAIRS This statement is to be completed by every debtor. Spouses filing a joint petition may file a single statement on which the information for both spouses is combined. If the case is filed under Chapter 12 or Chapter 13, a married debtor must furnish information for both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed. An individual debtor engaged in business as a sole proprietor, partner, family farmer, or self-employed professional, should provide the information requested on this statement concerning all such activities as well as the individual’s personal affairs. Questions 1–15 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also must complete Questions 16–21. Each question must be answered. If the answer to any question is “None,” or the question is not applicable, mark the box labeled “None.” If additional space is needed for the answer to any question, use and attach a separate sheet properly identified with the case name, case number (if known), and the number of the question. DEFINITIONS “In business.” A debtor is “in business” for the purpose of this form if the debtor is a corporation or partnership. An individual debtor is “in business” for the purpose of this form if the debtor is or has been, within the two years immediately preceding the filing of this bankruptcy case, any of the following: an officer, director, managing executive, or person in control of a corporation; a partner, other than a limited partner, of a partnership; a sole proprietor or self-employed. “Insider.” The term “insider” includes but is not limited to: relatives of the debtor; general partners of the debtor and their relatives; corporations of which the debtor is an officer, director, or person in control; officers, directors, and any person in control of a corporate debtor and their relatives; affiliates of the debtor and insiders of such affiliates; any managing agent of the debtor. 11 U.S.C. § 101(30). 1. None Income from employment or operation of business s State the gross amount of income the debtor has received from employment, trade, or profession, or from operation of the debtor’s business from the beginning of this calendar year to the date this case was commenced. State also the gross amounts received during the two years immediately preceding this calendar year. (A debtor that maintains, or has maintained, financial records on the basis of a fiscal rather than a calendar year may report fiscal year income. Identify the beginning and ending dates of the debtor’s fiscal year.) If a joint petition is filed, state income for each spouse separately. (Married debtors filing under Chapter 12 or Chapter 13 must state income of both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) AMOUNT SOURCE (If more than one) n 2. None Income other than from employment or operation of business s State the amount of income received by the debtor other than from employment, trade, profession, or operation of the debtor’s business during the two years immediately preceding the commencement of this case. Give particulars. If a joint petition is filed, state income for each spouse separately. (Married debtors filing under Chapter 12 or Chapter 13 must state income for each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) AMOUNT SOURCE 3. None a. Payments to creditors List all payments on loans, installment purchases of goods or services, and other debts, aggregating more than $600 to any creditor, made within 90 days immediately preceding the commencement of this case. (Married debtors filing under Chapter 12 or Chapter 13 must include payments by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATES OF PAYMENTS AMOUNT PAID AMOUNT STILL OWING s NAME AND ADDRESS OF CREDITOR None b. s List all payments made within one year immediately preceding the commencement of this case, to or for the benefit of, creditors who are or were insiders. (Married debtors filing under Chapter 12 or Chapter 13 must include payments by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATES OF PAYMENTS AMOUNT PAID AMOUNT STILL OWING NAME AND ADDRESS OF CREDITOR; RELATIONSHIP TO DEBTOR 4. None a. Suits, executions, garnishments and attachments List all suits to which the debtor is or was a party within one year immediately preceding the filing of this bankruptcy case. (Married debtors filing under Chapter 12 or Chapter 13 must include information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) NATURE OF PROCEEDING COURT AND LOCATION STATUS OR DISPOSITION s CAPTION OF SUIT AND CASE NUMBER n None b. s Describe all property that has been attached, garnished or seized under any legal or equitable process within one year immediately preceding the commencement of this case. (Married debtors filing under Chapter 12 or Chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATE OF SEIZURE DESCRIPTION AND VALUE OF PROPERTY NAME AND ADDRESS OF PERSON FOR WHOSE BENEFIT PROPERTY WAS SEIZED 5. None Repossessions, foreclosures and returns s List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of foreclosure or returned to the seller within one year immediately preceding the commencement of this case. (Married debtors filing under Chapter 12 or Chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) NAME AND ADDRESS OF CREDITOR OR SELLER DATE OF REPOSSESSION, FORECLOSURE SALE, TRANSFER OR RETURN DESCRIPTION AND VALUE OF PROPERTY 6. None a. Assignments and receiverships Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the commencement of this case. (Married debtors filing under Chapter 12 or Chapter 13 must include any assignment by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATE OF ASSIGNMENT TERMS OF ASSIGNMENT OR SETTLEMENT s NAME AND ADDRESS OF ASSIGNEE n None b. s List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year immediately preceding the commencement of this case. (Married debtors filing under Chapter 12 or Chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) NAME AND LOCATION OF COURT; CASE TITLE & NUMBER DESCRIPTION AND VALUE OF PROPERTY NAME AND ADDRESS OF CUSTODIAN DATE OF ORDER 7. None Gifts s List all gifts or charitable contributions made within one year immediately preceding the commencement of this case except ordinary and usual gifts to family members aggregating less than $200 in value per individual family member and charitable contributions aggregating less than $100 per recipient. (Married debtors filing under Chapter 12 or Chapter 13 must include gifts or contributions by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) NAME AND ADDRESS OF PERSON OR ORGANIZATION RELATIONSHIP TO DEBTOR, IF ANY DATE OF GIFT DESCRIPTION AND VALUE OF GIFT 8. None Losses s List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement of this case or since the commencement of this case. (Married debtors filing under Chapter 12 or Chapter 13 must include losses by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DESCRIPTION AND VALUE OF PROPERTY DESCRIPTION OF CIRCUMSTANCES AND, IF LOSS WAS COVERED IN WHOLE OR IN PART BY INSURANCE, GIVE PARTICULARS DATE OF LOSS 9. None Payments related to debt counseling or bankruptcy s List all payments made or property transferred by or on behalf of the debtor to any person, including attorneys, for consultation concerning debt consolidation, relief under the bankruptcy law or preparation of a petition in bankruptcy within one year immediately preceding the commencement of this case. NAME AND ADDRESS OF PAYEE DATE OF PAYMENT; NAME OF PAYOR IF OTHER THAN DEBTOR AMOUNT OF MONEY OR DESCRIPTION AND VALUE OF PROPERTY 10. Other transfers None a. s List all other property, other than property transferred in the ordinary course of the business or financial affairs of the debtor, transferred either absolutely or as security within one year immediately preceding the commencement of this case. (Married debtors filing under Chapter 12 or Chapter 13 must include transfers by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DESCRIBE PROPERTY TRANSFERRED AND VALUE RECEIVED NAME AND ADDRESS OF TRANSFEREE; RELATIONSHIP TO DEBTOR DATE 11. Closed financial accounts None s List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed, sold, or otherwise transferred within one year immediately preceding the commencement of this case. Include checking, savings, or other financial accounts, certificates of deposit, or other instruments; shares and share accounts held in banks, credit unions, pension funds, cooperatives, associations, brokerage houses and other financial institutions. (Married debtors filing under Chapter 12 or Chapter 13 must include information concerning accounts or instruments held by or for either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) NAME AND ADDRESS OF INSTITUTION TYPE AND NUMBER OF ACCOUNT AND AMOUNT OF FINAL BALANCE AMOUNT AND DATE OF SALE OR CLOSING 12. Safe deposit boxes None s List each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables within one year immediately preceding the commencement of this case. (Married debtors filing under Chapter 12 or Chapter 13 must include boxes or depositories of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) NAME AND ADDRESS OF BANK OR OTHER DEPOSITORY NAMES AND ADDRESSES OF THOSE WITH ACCESS TO BOX OR DEPOSITORY DESCRIPTION OF CONTENTS DATE OF TRANSFER OR SURRENDER, IF ANY 13. Setoffs None s List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding the commencement of this case. (Married debtors filing under Chapter 12 or Chapter 13 must include information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) NAME AND ADDRESS OF CREDITOR DATE OF SETOFF AMOUNT OF SETOFF 14. Property held for another person None List all property owned by another person that the debtor holds or controls. NAME AND ADDRESS OF OWNER DESCRIPTION AND VALUE OF PROPERTY LOCATION OF PROPERTY s 15. Prior address of debtor None s If the debtor has moved within the two years immediately preceding the commencement of this case, list all premises which the debtor occupied during that period and vacated prior to the commencement of this case. If a joint petition is filed, report also any separate address of either spouse. ADDRESS NAME USED DATES OF OCCUPANCY n The following questions are to be completed by every debtor that is a corporation or partnership and by any individual debtor who is or has been, within the two years immediately preceding the commencement of this case, any of the following: an officer, director, managing executive, or owner of more than 5 percent of the voting securities of a corporation; a partner, other than a limited partner, of a partnership; a sole proprietor or otherwise self-employed. (An individual or joint debtor should complete this portion of the statement only if the debtor is or has been in business, as defined above, within the two years immediately preceding the commencement of this case.) 16. Nature, location and name of business None a. s b. c. If the debtor is an individual, list the names and addresses of all businesses in which the debtor was an officer, director, partner, or managing executive of a corporation, partnership, sole proprietorship, or was a self-employed professional within the two years immediately preceding the commencement of this case, or in which the debtor owned 5 percent or more of the voting or equity securities, within the two years immediately preceding the commencement of this case. If the debtor is a partnership, list the names and addresses of all businesses in which the debtor was a partner or owned 5 percent or more of the voting securities, within the two years immediately preceding the commencement of this case. If the debtor is a corporation, list the names and addresses of all businesses in which the debtor was a partner or owned 5 percent or more of the voting securities, within the two years immediately preceding the commencement of this case. BEGINNING AND ENDING DATES OF OPERATION NAME ADDRESS NATURE OF BUSINESS 17. Books, records and financial statements None a. s List all bookkeepers and accountants who within the six years immediately preceding the filing of this bankruptcy case kept or supervised the keeping of books of account and records of the debtor. DATES SERVICES RENDERED NAME AND ADDRESS None b. s List all firms or individuals who within the two years immediately preceding the filing of this bankruptcy case have audited the books of account and records, or prepared a financial statement of the debtor. DATES SERVICES RENDERED NAME AND ADDRESS n None c. s List all firms or individuals who at the time of the commencement of this case were in possession of the books of account and records of the debtor. If any of the books of account and records are not available, explain. ADDRESS NAME None d. s List all financial institutions, creditors and other parties, including mercantile and trade agencies, to whom a financial statement was issued within the two years immediately preceding the commencement of this case by the debtor. DATE ISSUED NAME AND ADDRESS 18. Inventories None a. s List the dates of the last two inventories taken of your property, the name of the person who supervised the taking of each inventory, and the dollar amount and basis of each inventory. INVENTORY SUPERVISOR DOLLAR AMOUNT OF INVENTORY (Specify cost, market or other basis) DATE OF INVENTORY None b. List the name and address of the person having possession of the records of each of the two inventories reported in a., above. NAME AND ADDRESSES OF CUSTODIAN OF INVENTORY RECORDS s DATE OF INVENTORY 19. Current partners, officers, directors and shareholders None a. If the debtor is a partnership, list the nature and percentage of partnership interest of each member of the partnership. NATURE OF INTEREST PERCENTAGE OF INTEREST s NAME AND ADDRESS n None b. s If the debtor is a corporation, list all officers and directors of the corporation, and each stockholder who directly or indirectly owns, controls, or holds 5 percent or more of the voting securities of the corporation. TITLE NATURE AND PERCENTAGE OF STOCK OWNERSHIP NAME AND ADDRESS 20. Former partners, officers, directors and shareholders None a. s If the debtor is a partnership, list each member who withdrew from the partnership within one year immediately preceding the commencement of this case. ADDRESS DATE OF WITHDRAWAL NAME None b. s If the debtor is a corporation, list all officers or directors whose relationship with the corporation terminated within one year immediately preceding the commencement of this case. TITLE DATE OF TERMINATION NAME AND ADDRESS 21. Withdrawals from a partnership or distributions by a corporation None s If the debtor is a partnership or corporation, list all withdrawals or distributions credited or given to an insider, including compensation in any form, bonuses, loans, stock redemptions, options exercised and any other perquisite during one year immediately preceding the commencement of this case NAME AND ADDRESS OF RECIPIENT; RELATIONSHIP TO DEBTOR DATE AND PURPOSE OF WITHDRAWAL AMOUNT OF MONEY OR DESCRIPTION AND VALUE OF PROPERTY [If completed by an individual or individual and spouse] I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and any attachments thereto and that they are true and correct. Date _______________________ Date _______________________ Signature of Debtor ___________________________________________________________________ Signature of Joint Debtor (if any) _______________________________________________________ CERTIFICATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document. Printed or Typed Name of Bankruptcy Petition Preparer Social Security No. Address Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document: If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person. X Signature of Bankruptcy Petition Preparer Date A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fine or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156. [If completed by or on behalf of a partnership or corporation] I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and any attachments thereto and that they are true and correct to the best of my knowledge, information and belief. Date _______________________ Signature __________________________________________________________________________ ___________________________________________________________________________________ Print Name and Title [An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.] _________ continuation sheets attached Penalty for presenting fraudulent claim: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 and 3571. n Form 8. CHAPTER 7 INDIVIDUAL DEBTOR’S STATEMENT OF INTENTION UNITED STATES BANKRUPTCY COURT _________________________ DISTRICT OF _________________________ In re _________________________________________________ , (Name) Debtor Case No. __________________________________ (If known) Chapter __________________________________ 1. I have filed a schedule of assets and liabilities which includes consumer debts secured by property of the estate. 2. I intend to do the following with respect to the property of the estate which secures those consumer debts: a. Property to be surrendered. Description of Property 1. _________________________________________________________ 2. _________________________________________________________ 3. _________________________________________________________ Creditor’s Name _______________________________________________ _______________________________________________ _______________________________________________ b. Property to be retained. [Check any applicable statement.] Property Description of property Creditor’s name is claimed as exempt Property will be redeemed pursuant to 11 U.S.C. § 722 Debt will be reaffirmed pursuant to 11U.S.C.§524(c) 1. 2. 3. 4. 5. Date: ______________________________ ___________________________________________________ Signature of Debtor CERTIFICATION OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document. Printed or Typed Name of Bankruptcy Petition Preparer Social Security No. Address Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document: If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person. X Signature of Bankruptcy Petition Preparer Date A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fine or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156. FORM 3. APPLICATION TO PAY FILING FEE IN INSTALLMENTS UNITED STATES BANKRUPTCY COURT _________________________ DISTRICT OF _________________________ In re _______________________________________________, Debtor Case No._____________________________ (If known) Chapter _____________________________ APPLICATION TO PAY FILING FEE IN INSTALLMENTS 1. 2. In accordance with Fed. R. Bankr. P. 1006, I apply for permission to pay the Filing Fee amounting to $______________ in installments. I certify that I am unable to pay the Filing Fee except in installments. 3. I further certify that I have not paid any money or transferred any property to an attorney for services in connection with this case and that I will neither make any payment nor transfer any property for services in connection with this case until the filing fee is paid in full. 4. I propose the following terms for the payment of the Filing Fee* $ _____________________________ Check one s s With the filing of the petition, or On or before _________________ $ _________________________ $ _________________________ $ _________________________ on or before ________________________________ on or before ________________________________ on or before ________________________________ * The number of installments proposed shall not exceed four (4), and the final installment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after filing the petition. Fed. R. Bankr. P. 1006(b)(2). 5. I understand that if I fail to pay any installment when due my bankruptcy case may be dismissed and I may not receive a discharge of my debts. __________________________________________________ Signature of Debtor Date (In a joint case, both spouses must sign.) __________________________________________________ Signature of Joint Debtor (if any) Date _______________________________________________ Signature of Attorney Date _______________________________________________ Name of Attorney CERTIFICATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document. I also certify that I will not accept money or any other property from the debtor before the filing fee is paid in full. Printed or Typed Name of Bankruptcy Petition Preparer Social Security No. Address Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document: If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person. X Signature of Bankruptcy Petition Preparer Date A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fine or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156. ORDER APPROVING PAYMENT OF FILING FEE IN INSTALLMENTS IT IS ORDERED that the debtor(s) pay the filing fee in installments on the terms proposed in the foregoing application. IT IS FURTHER ORDERED that until the filing fee is paid in full the debtor shall not pay any money for services in connection with this case, and the debtor shall not relinquish any property as payment for services in connection with this case. BY THE COURT Date: ______________________________ ___________________________________________________________ To whom it may concern: On ____________________________________, I filed a voluntary petition under Chapter 7 of the U.S. Bankruptcy Code. The case number is _______________________. Under 11 U.S.C. § 362(a), you may not: • take any action against me or my property to collect any debt. • enforce any lien on my real or personal property. • repossess any property in my possession. • discontinue any service or benefit currently being provided to me. • take any action to evict me from where I live. A violation of these prohibitions may be considered contempt of court and punished accordingly. Very truly yours, Form 20A. Notice of Motion or Objection UNITED STATES BANKRUPTCY COURT _________________________ DISTRICT OF _________________________ In re ________________________________________________________ , (Name) Debtor Case No. ________________________________ (If known) Chapter _________________________________ NOTICE OF [MOTION TO ] [OBJECTION TO ] _________________________ has filed papers with the court to [relief sought in motion or objection]. Your rights may be affected. You should read these papers carefully and discuss them with your attorney, if you have one in this bankruptcy case. (If you do not have an attorney, you may wish to consult one.) If you do not want the court to [relief sought in motion or objection], or if you want the court to consider your views on the [motion] [objection], then on or before (date ), you or your attorney must: File with the court a written request for a hearing [or, if the court requires a written response, an answer, explaining your position] at: [address of the bankruptcy clerk’s office] If you mail your [request] [response] to the court for filing, you must mail it early enough so the court will receive it on or before the date stated above. You must also mail a copy to: [movant’s attorney’s name and address] [names and addresses of others to be served] Attend the hearing scheduled to be held on (date) , (year) , at ___ a.m./p.m. in Courtroom ____________________, United States Bankruptcy Court, [address]. Other steps required to oppose a motion or objection under local rule or court order. If you or your attorney do not take these steps, the court may decide that you do not oppose the relief sought in the motion or objection and may enter an order granting that relief. Date: ________________________ Signature: __________________________________ Name:_____________________________________ Address: ___________________________________ Your Name, Address & Phone Number: In Pro Per UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF In re ) ) ) ) Debtor(s) ) AMENDMENT COVER SHEET Case No. Presented herewith are the original and one copy of the following: Voluntary Petition (Note: Spouse may not be added or deleted subsequent to initial filing.) Schedule A—Real Property Schedule B—Personal Property Schedule C—Property Claimed as Exempt Schedule D—Creditors Holding Secured Claims Schedule E—Creditors Holding Unsecured Priority Claims Schedule F—Creditors Holding Unsecured Nonpriority Claims Schedule G—Executory Contracts and Unexpired Leases Schedule H—Codebtors Schedule I—Current Income of Individual Debtor(s) Schedule J—Current Expenditures of Individual Debtor(s) Summary of Schedules Statement of Financial Affairs I have enclosed a $20 fee because I am adding new creditors or changing addresses after original Meeting of Creditors Notice has been sent. Signature of Debtor I (we) Signature of Debtor’s Spouse and , the debtor(s) in this case, declare under penalty of perjury that the information set forth in the amendment attached hereto consisting of Dated: pages is true and correct to the best of my (our) information and belief. , 19 Signature of Debtor Signature of Debtor’s Spouse Your Name, Address & Phone Number: In Pro Per UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF In re ) ) ) ) Debtor(s) ) NOTICE OF CHANGE OF ADDRESS Case No. Social Security Number (H): Social Security Number (W): MY (OUR) FORMER MAILING ADDRESS AND PHONE NUMBER WAS: Name: Street: City: State/Zip: Phone: ( ) PLEASE BE ADVISED THAT AS OF MAILING ADDRESS AND PHONE NUMBER IS: Name: Street: City: State/Zip: Phone: ( ) , 19 , MY (OUR) NEW Signature of Debtor Signature of Debtor’s Spouse Your Name, Address & Phone Number: In Pro Per UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF In re ) ) ) ) Debtor(s) ) Case No. SUPPLEMENTAL SCHEDULE FOR PROPERTY ACQUIRED AFTER BANKRUPTCY DISCHARGE TO:____________________________________________, Trustee. This is to inform you that I (we) have received the following item of property since my (our) discharge but within the 180-day period after filing my (our) Bankruptcy Petition under Bankruptcy Rule 1007 (h): This property was obtained through an inheritance, marital settlement agreement or divorce decree, death benefits or life insurance proceeds, or other (specify): I (we) claim this property exempt under the following law: I (we) and , the debtor(s) in this case, declare under penalty of perjury that the foregoing is true and correct. Dated: ____________________, 19_____ Signature of Debtor Signature of Debtor’s Spouse DAILY EXPENSES Date: Item s s s s s s s s s s s s s s s Date: Cost Item s s s s s s s s s s s s s s s Cost Date: Item s s s s s s s s s s s s s s s Date: Cost Item s s s s s s s s s s s s s s s Cost 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Your Name, Address & Phone Number: In Pro Per UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF In re ) ) ) ) Debtor(s) ) Case No. PROOF OF SERVICE BY MAIL I, , declare that: I am over the age of 18 years and not a party to the within bankruptcy. I reside in or am employed in the County of . My residence/business address is . On , I served the within by placing a true and correct copy of it in a sealed envelope with first-class postage fully prepaid, in the United States mail at , addressed as follows: I declare under penalty of perjury that the foregoing is true and correct. Executed on 19 at , . Signature